Early on a January morning, 33-year-old Lucianny Salvador was crossing the street with her son Enoc, when suddenly all she knew was that she had been knocked to the ground, struck on her left side by a car. 7-year-old Enoc was being dragged by the car, ultimately pushed several yards before it came to a stop. To make the situation even more critical, Lucianny was 34 weeks pregnant at the time.
Maimonides is home to the borough’s only pediatric trauma center and its largest and most highly specialized obstetrics and neonatology programs – putting all of the advanced resources needed for this complex case in one place—and thankfully for the Salvador family, that place wasn’t far from home. Lucianny and Enoc were transported immediately to Maimonides, as level 2 adult/obstetric and level 1 pediatric trauma cases, respectively. The ambulance phoned ahead so the emergency department could prepare for this complex case.
Team Maimo Quickly Readied Themselves for Action
“Even before their arrival, the EM trauma group and Surgical Trauma Team were standing by,” said Jeffrey Nicastro, MD, trauma and critical care surgeon at Maimonides. “Within minutes, the pediatric EM team, Obstetric Call team and Neonatal response teams were present and prepared to act.”
Enoc arrived with significant facial trauma, including a scalp degloving injury and multiple facial fractures — the medical team was highly suspicious of more substantial traumatic injury that was not immediately evident.
Meanwhile, Lucianny was showing signs of serious abdominal trauma, but was hemodynamically stable upon arriving. It became apparent that the toll of the accident had caused significant distress to the fetus, who was exhibiting a dangerously low heart rate, suggesting a case of placental abruption, which can be caused by abdominal trauma. The emergency room doctors conducted a fast assessment and agreed an immediate C-section was necessary, with an exploratory laparotomy to follow.
Luckily, this wasn’t Lucianny’s first time at Maimonides; she is a regular patient of obstetrician Vijaya Bayya, MD, who was one of the eight doctors and six more care team members present in the OB operating room.
“I love my OB,” Lucianny said. “I’ve known her a long time.”
A Streamlined Surgical Collaboration Between the OB and Trauma Departments
Despite confirmation of the traumatic placental abruption suspected on Lucianny’s arrival, the surgical OB team delivered a baby boy in good health, quickly showing an Apgar score of 7. The neonatal ICU team took over from there for the baby.
“It was amazing team work,” said Alok Bhutada, MD, director of newborn medicine at Maimonides. “Different departments came together and each department did its part.”
A team of six trauma surgeons, including Dr. Nicastro and Rachel Caiafa, MD, took over caring for Lucianny. They began the exploratory laparotomy right there in the OB operating room and quickly located a liver laceration with active bleeding. She was also treated for pulmonary contusions, a left hemopneumothorax, and a left humeral fracture.
“I had asked for help with these patients from my trauma colleagues who immediately responded to the call and assisted me with surgery and following up on [Enoc],” Dr. Nicastro said. “Despite the OB operating room not being in the abdominal trauma business, they did a great job assisting and getting us what we needed.”
“I remember the trauma team,” Lucianny said. “They were amazing. Giving me information on what happened, what they had done, every time I needed them to come in. They were very helpful.”
Nearby in the pediatric emergency room, doctors determined that Enoc had evaded significant intracranial and torso trauma, but sustained serious facial injuries, and required occulo-plastic reconstruction of his orbit. While Kings County Hospital Center often sends its most complex trauma cases to Maimonides, this procedure is one subspecialty that Maimonides sends to Kings County, and so he was transferred there for treatment.
Expert Care and Compassionate Support While Healing
By early afternoon, doctors were optimistic for the outcome of all three patients. When Lucianny woke up after her surgery, she was attended to by her ICU nurses and was thrilled to learn that her baby, Lucas, was healthy and being cared for in the NICU while she recovered, ultimately staying at the medical center for 11 days. Lucianny, Enoc, and Lucas all recovered fully.
“The ICU nurses – they were amazing,” she said. “They were always very nice, always there when I call for something. They brought me photos of my baby when I was in the ICU. Always keeping me informed on the results of the tests that they performed on the baby. A Nurse from NICU always brought photos of the baby’s foot print, and came to the room and updated me with how well the baby was doing. It meant a lot as I lay there trying to heal that the baby was okay.”
In the end, about 40 Maimonides doctors, nurses, and other patient care professionals, along with even more ancillary staff members, were involved in this unique, complex integrated response from adult emergency medicine, pediatric emergency medicine, trauma surgery, obstetrics, maternal-fetal medicine, pediatrics, radiology, and the neonatal ICU.
“There are many moving parts required to care for multiple serious traumas at once, and the complexity was compounded by pregnancy and fetal distress,” said Dr. Nicastro. “The expertise, collaboration, energy, and heart that every one of the teams involved in the care of these injured patients demonstrated was unequalled in my 28+ year career in trauma.”
After being discharged, Lucianny was grateful for the individualized and compassionate care she received from all of the team involved in her care, especially her nurses, whose encouragement helped her to heal.
“The nurses came over to say hi before I left,” she said. “My heart was warmed … It gave me strength to get better every day. I was in pain, but every day, I had to try. Every time I got up, in spite of the pain, they gave me encouragement and they [made me] feel happy.”